(Stroke. 1997;28:1340-1344.)
© 1997 American Heart Association, Inc.
Articles |
Impaired Dynamic Cerebral Autoregulation in Carotid Artery Stenosis
From the Department of Clinical Neurosciences, King's College School of Medicine and Dentistry and the Institute of Psychiatry, London, UK.
Correspondence to Dr Hugh Markus, Department of Clinical Neurosciences, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. E-mail h.markus{at}iop.bpmf.ac.uk
Background and Purpose If it could be determined whether cerebral blood flow can be maintained (autoregulated) during transient falls in arterial blood pressure, we might be able to identify patients with carotid stenosis who are at risk of stroke. However, conventional methods of determining autoregulation in such patients are invasive and/or expensive.
Methods We used a new noninvasive method to estimate dynamic cerebral autoregulation in 27 patients with carotid stenosis and 21 age-matched normal controls. After a stepwise fall in arterial blood pressure, we determined the rate of rise of middle cerebral artery blood flow velocity compared with that of arterial blood pressure. We compared the method with a conventional method of determining cerebral hemodynamics, CO2 reactivity.
Results Autoregulatory index (ARI) was significantly reduced in middle cerebral arteries ipsilateral to a stenosed/occluded carotid artery: mean±SD 3.3±2.2 compared with normal controls (6.3±1.1; P<.0001) and nonstenosed carotid arteries in patients (5.9±2.1; P<.002). A subgroup of patients with severe impairment was identified. ARI returned to normal after carotid endarterectomy was performed. In a number of cases, ARI was impaired in the presence of CO2 reactivity.
Conclusions This simple technique allows identification of impaired autoregulation in patients with carotid artery disease. It may allow identification of patients at risk from transient falls of blood pressure as may occur at the onset of antihypertensive therapy and during surgery. It may allow a subgroup of patients with asymptomatic carotid stenosis who are at risk of hemodynamic stroke to be identified.
Key Words: carotid stenosis • autoregulation • cerebral circulation • ultrasonics
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